Suturing instrument



March 20, 1956 F. G. TODT, sR., ET AL SUTURING INSTRUMENT Filed Aug. 12, 1954 34 FIG. 4.

i D: g /46 FIG. 5.

INVENTORS FRED G. TODT Sr WILLIAM STRECKENBEIN a FRED e. TODT, Jr.

a K FIG. 6. )a'ae; ATTORIIEYS 7 United States Patent Ofiice 2,738,790 Patented Mar. 20, 1956 SUTURING INSTRUMENT Fred G. Todt, Sr., Audubon, N. J., and William Streckenhein, Philadelphia, and Fred G. Todt, Jr., Manon, Pa.,

assignors to The George P. Pilling & Son Company, Philadelphia, Pa., a corporation of Pennsylvania Application August 12, 1954, Serial No. 449,418 8 Claims. (Cl. 128-334) This invention relates to surgical instruments and has particular reference to an instrument for use in stitching the mitral valve of the heart. The stitching of the mitral valve of the heart is attended with great difliculties not only as to access but because the stitching must be accomplished by the surgeon by feel only. The stitching, furthermore, must be accomplished utilizing tissue surrounding the heart which is provided for this purpose in the form of a strip which is not readily handled by an instrument. In accordance with the present invention there is provided an instrument for stitching the mitral valve, the instrument being associated with a finger of the surgeon and of such nature that by feel he may effect the proper operation. The instrument is designed particularly to insert a cord which is then used to pull into position the tissue which is to form the final suture.

The objects of the invention relate to the provision of an instrument for the foregoing purposes and will be better understood from consideration of the following description in conjunction with the accompanying drawing, in which:

Figure l is a plan view of the instrument showing the nature of its association with a cord and the finger of the surgeon;

Figure 2 is an elevation of the instrument;

Figure 3 is an elevation of the needle-containing assembly of the instrument;

Figure 4 is an enlarged fragmentary elevation showing, in particular, the pointed end of the needle and the dam hereafter described for limiting the escape of blood;

Figure 5 is a plan view of what is illustrated in Figure 4, indicating particularly the sharpening of the needle; and

Figure 6 is an enlarged fragmentary sectional view showing details and from which the operations involved will be made clear.

All of the parts of the instrument are desirably formed of stainless steel. Referring first to Figures 1 and 2, the instrument comprises what will be referred to as a body portion 2 in the form of a rigid strip of the stainless steel having a forward end indicated at 4 and a rear end involving a turned finger hold 6 provided with slots 8 for the passage of flanges on the needle assembly as will be hereafter described. A lug 10 projecting from the body portion serves as a stop. The forward end 4 of the body portion is curved, as indicated particularly in Figure 1, and is provided with a deep slot 12 leaving at its forward end a hook-like extension 14. This extension 14 is surmounted by a loop-like tip 16 provided with a passage 18 and having its sides provided with transverse openings 20 for the reception of a cord S which is used for the placement of the tissue suture. The forward section of the body portion 2 has secured thereto, for example, by soldering, a flattened tube 22 which terminates forwardly at the position of the slot 12. Arranged to be mounted in association with the body portion 2 is a needle assembly which is particularly illustrated separately in Figure 3. This comprises a slide 24 provided with upper and lower flanges 26 and 28 which are arranged to embrace the rearward section of the body portion 2, the slots 8 being provided for the assembly of this slide upon the body portion. To the slide there is secured a turned member 30 arranged to be pushed by the thumb of the surgeon. Additionally, the slide carries finger rings 34 and 36 for retraction purposes. Secured in a socket 32 mounted on the slide 24 is the rear end of a needle 38 which is provided at its forward end with a hook 40. The lower edge of the hook 40 indicated at 42 is rounded so as not to have a cutting action and the same is true of the lower edge 43 of the needle to the rear of the hook. The upper edge of the needle, however, is sharpened at 44 to provide a cutting edge and a sharp point 46.

In use, the needle is arranged to project in and through the flattened tube 22 and the needle is provided to the rear of the hook and at a position where it will not leave the tube 22 with an enlarged dam 48 which is arranged to impede the loss of blood during the operation. This dam has a free but quite close fit in the tube 22.

The needle 38 is formed of spring steel and, desirably, its forward end has a radius of curvature which is less than that of the forward end of the body portion and tube 22. Thus there is provided some degree of friction against free movement of the needle relative to the body portion and a shape is secured such that as the end of the needle is projected from the forward end of the tube 22 it will pass through the opening 18, as indicated in construction lines in Figure 6.

In the operation of the device, the surgeon will have on his right hand the usual rubber glove and in some cases the surgeon will have the instrument clamped to his hand by drawing over the instrument and his gloved hand a second rubber glove having the outer portion of the index finger removed. The gloves are not illustrated in Figure l but it will be understood that for use the instrument is either held by the fingers of the surgeon or by encasement in the second rubber glove mentioned above in such fashion that the forward portion of the body por tion 2 lies along the index finger, the forward end of which is in overlapping relationship with the slot 12. Prior to use, a cord S is threaded through the holes 20 across the opening 18. The needle 38 is initially withdrawn, being located in the position illustrated in full lines in Figure 6. In preliminary preparation, the heart will have been provided with an opening surrounded by a purse string suture, and the surgeon will insert his finger and the forward end of the instrument through this opening whereupon the suture will be drawn tight to surround the surgeons finger and the instrument. The purpose of the dam 48 will now be evident, since in its absence the tube 22 would form a free passage for the escape of blood. With the dam 48 present, the flow is at least very substantially reduced while the dam 48 being of limited extent does not provide an undesired amount of friction against movement of the needle.

The surgeon by feel can now locate the mitral valve and can press the tissue thereof to be sutured by his finger into the slot 12. When such positioning is effected the needle assembly is pushed forwardly by engagement with the other hand of the member 30, the forward movement elfecting penetration of the tissue which is cut by the point 46 and the knife-like edge provided at 44, the forward movement being stopped by engagement of slide 24 with lug 10 in such position that the hook of the needle extends beyond the position of the cord S as indicated in the construction lines in Figure 6. During the forward movement the cord is cammed downwardly by the rounded lower edge of the hook. A retraction of the needle through the medium of the finger rings 34 and 36 causes the hook to grasp the portion of the cord projecting across the opening 18 between the holes 20 and a loop is thus drawn rearwardly through the tissue and through the tube 22. The cord S is made quite long and the withdrawal of the needle is effected completely from the tube 22, the slide 24 being removed from the body portion 2 of the instrument with the passage of the flanges 26: and 28 through, the slots 8.

The result is to make available to the surgeon and his assistants both the bight of the cord and its free ends. To the bight there may be then tied the end of the suture tissue which is then drawn by the cord through the valve and adjacent tissues of the heart to provide the final suture. In a complete operation, two instruments of the type described are used. The one illustrated is known as a right hand instrument. The other, known as a left hand instrument, is identical except that the slot 12 opens downwardly rather than upwardly (considering its association with the right index finger of the surgeon), and the needle is inverted and on the lower side of the body portion of the instrument. The left hand instrument, of course, also embodies the invention but need not be described since except for the reversals indicated its structure is identical with what has been described. This left hand instrument is used to form a second suture in the fashion above described. Other steps in the operation do not involve the use of the invention and are, accordingly, not detailed.

What is claimed is:

l. A surgical stitching instrument comprising an instrument body and a needle, said body being of extended form and including a hook at one end and guide means extending along one longitudinal edge thereof in which the needle is slidably mounted, said guide means terminating adjacent to the opening formed by said hook and positioned to guide one end of said needle for motion across the open side of the opening formed by said hook.

2. A surgical stitching instrument comprising an instrument body and a needle, said body being of fiat extended form and including a hook at one end and guide means extending along one longitudinal edge thereof in which the needle is slidably mounted, said guide means terminating adjacent to the opening formed by said hook and positioned to guide one end of said needle for motion across the open side of the opening formed by said hook, and the end of said hook being formed with an opening through which the end of the needle may pass.

3. A surgical stitching instrument comprising a curved instrument body and a flexible needle, said body being of extended form and including a hook at one end and longitudinally extending guide means in which the needle is slidably mounted, said guide means terminating adjacent to the opening formed by said hook and positioned to guide one end of said needle for motion across the open side of the opening formed by said hook.

4. A surgical stitching instrument comprising an instrument body and a needle, said body being of extended form and including a hook at one end and longitudinally extending guide means in which the needle is slidably mounted, said guide means terminating adjacent to the ,opening formed by said hook and positioned to guide one end of said needle for motion across the open side of the opening formed by said hook, means affixed to the other end of said needle in sliding engagement with the other end of said body and turned finger hold means affixed to said other ends of said body and said needle to provide for manipulation of the instrument.

5. A surgical stitching instrument comprising an instrument body and a needle, said needle having a hook formed in one end, said body being of extended form and including a hook at one endand longitudinally extending guide means in which the needle is slidably mounted, said guide means terminating adjacent to the opening formed by said body hook and positioned to guide said one end of said needle for motion across the open side of the Opening formed by said body hook, aligned bores in the portions of said body hook forming the sides of said opening therein, said openings and said needle guide means being positioned so that the opening of the needle hook passes between said bores.

6. A surgical stitching instrument comprising an instrument body and a needle, said body being of extended form and including a hook at one end and longitudinally extending guide means in which the needle is slidably mounted, said guide means terminating adjacent to the opening formed by said-hook and positioned to guide one end of said needle for motion across the open side of theopening formed by said hook, said one end of said eedle being sharpened to a point and the side of the needle extending from the point and outwardly of said hook opening beingsharpened to provide. a cutting edge.

7. A surgical stitching instrument comprising a curved instrument body and a flexible needle, said body being of extended form and including a hookat one end and longitud nally extending tubular guide means in which the needle is slidably mounted, said guide means terminating adjacent to the opening formed by said hook and positioned to guide one end of said needle for motion across the open side of the opening formed by said hook, said needle being loosely fitted within said tubular guide and means providing snug sliding engagement between only a portion of said needle and said guide tube.

8. A surgical stitching instrument comprising an instrument body and a needle, said'bodybeing of extended form and .including a hook at one end and longitudinally extending guide means in Which the needle is slidably mounted, said guide means terminating adjacent to the opening formed by said hook and positioned to guide one end of said needle for motion acrossthe open side of the opening formed by said hook, and stop means for limiting the extent of motion of the needle beyond the end of said hook.

References Cited:in the file of this patent UNITED STATES PATENTS 43,098 Cooper June 14, 1864 230,073 Seyfarth July 13, 1880 1,822,330 Ainslie Sept. 8, 1931 

